Laserfiche WebLink
PERMITTEE NAMEJADDRESS ilntfudr facilife \'ame/l~~ra(ian if Aiffirrnrl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) • <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />Form Approved. <br />OMB No. 2040-0004 - <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, fREOUENCY <br />OF SAMPLE <br /> EX I TYPE <br /> ANALYS <br />S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />~ rI <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ~ ~ <br /> MEASUREMENT <br /> ~a:: . <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 cr'rli(> under prnah) of law !hW t61\ d~xumrnt and rll allrchmenh wrre <br />ared under m) Aireclion ..r +uln•r. i\inn in acarrdance with a .)Hem dr.igrretl <br />re TELEPHONE DATE <br /> p <br />p <br />hr u\wrr Thal yualified prr.nnnd prvgx•rh gather and e\ahutr the informuoral <br /> whmittevl. F(u\c•A un m~ lnyuh') of lhr perwn nr pervm\ who nonage the .~\Irm. <br />~ <br /> or Ihax• pcr~rm\ dirnth rr\pnn.iMr Grr gathering the in(ormatiwn, the information <br /> <br />\IIhn11111Y( 1\, In the AeN u(m\ I.nowledgr and helkl. Irur. accurrle. and complete. <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE _ <br />- ~ <br />\ <br />~ - <br />J <br /> I am aware that therr are significant penrlticclor.uhmiuing fula• informulirm. TH <br />RIZ <br />T AREA <br /> ricnnmenl fnr Annwin; .iolalion. <br />rc\ihilip of fine and im <br />i <br />lin <br />lbe <br />d O <br />ED AGEN <br />OFFICER OR AU NUMBER <br />D YEAR MO DAY <br />TYPED OR PRINTED . <br />p <br />la <br />g <br />g <br />n <br />COMMENTS AND txrLArvr+l(vrv yr wrvT vw~tanvl~~ InCICrCn{:C on auaw nucnra ncr c~ <br />it <br />r r r.r r , <br />EPA F:;rm',3_%~-I ~Re~. : 99; Pre~nous er;ni2r-: <br />TI1t` Iti .t •~-ratt fOfill. PAGE OF <br />